civil air navigation services organisation

CANSO Asia Pacific

Regional Safety
Implementation
Strategy
In support of CANSO Global Strategy
for the Future of Safety in Air Traffic Management

2nd Edition
Published 2019 APAC Regional Safety Implementation Strategy 2nd Edition

Contents

1 Introduction................................................................................................................................ page 3

2 Overview of the Asia Pacific Region........................................................................................... page 3

3 Overview of CANSO Safety Strategy......................................................................................... page 5

4 Key Safety Priorities.................................................................................................................... page 8

5 Safety Implementation Plans and Progress................................................................................ page 9

6 Document Review ................................................................................................................... page 17

7 Document Amendments ......................................................................................................... page 17

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 APAC Regional Safety Implementation Strategy 2nd Edition

1
Introduction

This plan (referred to as the ‘APAC Regional Safety number of ANSPs in the region. In developing
Implementation Strategy’) sets out the strategic this plan, the Workgroup has cooperated through
context, safety priorities and supporting initiatives meetings and surveys to address the following
to implement the CANSO Global Strategy for questions:
the Future of Safety in Air Traffic Management
(ATM) in the Asia Pacific (APAC) region. This • Are we safe?
plan is intended to coordinate collaborative • Will we be safe in the future?
regional safety improvement actions, as well as • What do we need to do and prioritise to improve
providing a reference guide to inform individual air the safety of ATM operations?
navigation service providers’ (ANSPs’) own safety
programmes. The delivery of this plan will contribute to improving
the safety of aviation while supporting the ongoing
The APAC Regional Safety Implementation Strategy traffic growth across the region. It also aims to
has been developed by the CANSO APAC Safety support harmonisation of safety management
Workgroup which is represented by a growing capabilities across ANSPs in the long term.

2
Overview of the Asia Pacific Region

The APAC region is leading the world in air traffic The increasing traffic growth heightens the need
growth. According to the International Air Transport to acquire and integrate modern advanced
Association (IATA)1, this region is the biggest driver technologies and systems to support safe
of demand and the source of more than half the and efficient air navigation services. System
new passengers over the next two decades. By interoperability needs to improve to lift safety
2036 the region is expected to account for 3.5 performance across the region, given the air
billion annual passengers originating or terminating traffic density and complexity. Technological
in the region. transformations may also introduce new risks in
areas such as change management, human factors
This significant growth poses a range of safety and training in the transition to next-generation
challenges. For some ANSPs, traffic demand ATM technologies.
already exceeds existing capacity and capability
in places leading to safety challenges in regard The ANSPs in the region come from countries
to workload, resourcing and coordination issues. of diverse national cultures which also influence
Current airspace designs and route structures are safety cultures. There are considerable differences
being tested and require continual assessment and in the levels of safety management maturity. Some
review. ANSPs are in the initiating stage of implementing
a safety management system (SMS), while other
ANSPs are in the advanced stages of managing,
measuring and continuous improvement.

1 Source: https://www.iata.org/pressroom/pr/Pages/2017-10-24-01.aspx

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 APAC Regional Safety Implementation Strategy 2nd Edition

A number of similar safety risk factors are shared2 The challenges and opportunities associated with
by ANSPs in the region, including: traffic growth highlight the importance of evolving
our mindset and approach to safety management.
• Human performance: workload and fatigue ANSPs across the APAC region share a strong
issues in dealing with rapid traffic growth commitment to working together to ensure and
• Human factors: communication and coordination improve safety.
issues (e.g. non-standard phraseology, hear-
back / read-back errors, call sign confusion), Regional solutions are required beyond the
procedural compliance issues (e.g. shortcutting boundary of individual ANSPs, as the safety and
procedures when under workload pressure to efficiency of flights transcend national borders.
cope with traffic increases), integrating human These solutions are necessitated by growing
factors in incident investigation expectations of airspace users for more harmonised
• Technologies: limitation in the existing ATM and seamless ATM services. Collaboration and
tools to cope with increasing traffic complexity shared learning is the key to ensure aviation safety
(e.g. lack of suitable air traffic flow management in the region in times of significant demand and
systems, or tools to monitor and detect traffic change. These are the key drivers underpinning
conflicts) this plan.
• Airspace design limitations which are also
impacted by military airspace requirements
• Runway safety issues (e.g. runway incursions,
unstable approaches)
• Safety change management (e.g. communicating
changes, managing risks associated with
changes, managing risk information within the
ANSP).

2 The points reflect the common safety risk issues that were discussed at the CANSO
APAC Safety Workgroup meetings in December 2014 and May 2015.

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3
Overview of CANSO Safety Strategy

The APAC Regional Safety Implementation Safety is achieved by all individuals in the
Strategy builds on the four themes of the CANSO organisation taking responsibility and ownership
Global Strategy for the Future of Safety in ATM. The of their actions and behaviours. This should be
CANSO APAC Safety Workgroup has agreed on the supported by an environment that encourages and
relative importance of these themes to guide the supports honest reporting of errors and failures
development of this region’s safety priorities and without fear of punishment or ridicule. People
implementation plans. The four themes, described also need to be supported by training/education,
below, are the working definitions produced by the systems, tools and information so that they are
APAC Safety Workgroup. competent and capable to perform their work
safely and can effectively manage safety risks and
People Create Safety challenges.

The theme of ‘People Create Safety’ recognises Safety culture is ultimately set by the leadership
that people are our strength rather than weakness. of the organisation and the trust between the
It emphasises the importance of building a positive management and frontline personnel. Leaders’
safety culture, including embedding the Just commitment to safety improvement and
Culture principles, where the focus of safety is not demonstration of positive and proactive safety
on individual failures and errors but guided by the actions drive the standards of professionalism and
organisation’s clear definition and understanding level of safety performance of ANSPs.
of what constitute acceptable and unacceptable
behaviours.

It is essential that we continue to embrace a

continuous learning culture that is supported by
robust investigation processes, analysing causal
factors and contextual conditions. These learnings
must be used to strengthen systems to control risk
exposure and prevent reoccurrence of errors or
failures. It is equally important to acknowledge
areas within our operations that are performing well
and to pass on these learnings and experiences.

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 APAC Regional Safety Implementation Strategy 2nd Edition

Safety Intelligence Learning and Challenging

As ATM is becoming more complex while The theme of ‘Learning and Challenging’
incidents/accidents are becoming less frequent, recognises that ANSPs regionally are better
there is a heightened need to understand the risks prepared for tackling our safety challenges if
in our system and develop effective strategies to we work together as an ANSP community. By
ensure the risks are managed effectively. As a collaborating and learning together (e.g. through
result, safety management increasingly depends networks and regular information exchange), we
on collecting and understanding information from will be able to efficiently and effectively address
day-to-day operations to assess and understand common ATM safety risks, learn from lessons of
the performance of existing risk controls and other ANSPs, and contribute to safer skies.
performance variability so as to anticipate and
prepare for emerging risks. This theme is also about striving for higher
standards and not being content with the ‘status
The theme of ‘Safety Intelligence’ relates to how quo’. It requires maintaining vigilance about
ANSPs should gather and analyse data to address emerging risks/threats and constantly scanning
the key questions of “are we safe” and “will we be within and outside our organisations to seek
safe in the future”. It is about understanding what improvement. ‘Learning and Challenging’ also
types of data to collect, the obstacles that prevent depends on the safety culture where safety is on
us from gathering such data and prioritising the top of the organisation’s agenda and staff can feel
findings after the data is analysed. The objective is safe and supported to raise concerns or provide
to gain confidence over the safety performance of suggestions for safety improvement.
our services and guide the organisation’s decision-
making so that resources can be prioritised for key Tailored and Proportionate
safety improvement interventions and initiatives.
The theme of ‘Tailored and Proportionate’
‘Safety Intelligence’ is concerned with: recognises that we are resource-constrained and
• Collecting safety data from various sources, such must apply our finite resources where the best
as safety reports from staff, audits, surveys and safety benefits can be realised. It is about making
incident/accident investigations ‘how we do safety’ fit for current objectives and
• Analysing safety data against performance future challenges within each ANSP.
indicators/ targets
• Prioritising information to indicate key safety The approach to safety management needs to
risks, effectiveness of risk controls as well as be proportionate to the risk and complexity of
strengths and weaknesses of safety management the organisation. With limited resources, safety
processes processes are most effective when they are
• Understanding factors which influence positive tailored to suit the organisation and integrated in
performance outcomes. the day-to-day operations and project lifecycles.
Fundamentally this is how we adopt an effective
‘Safety Intelligence’ is critically linked with ‘People business approach to safety where the balance
Create Safety’. Valuable safety data relies on an between safety and other business outcomes is
open, just and proactive culture. optimised.

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 APAC Regional Safety Implementation Strategy 2nd Edition

Relative Importance of Themes in the Asia Pacific Region

The CANSO APAC Safety Workgroup has assessed the relative importance of the four
themes from the Global Strategy for the region (as illustrated in Figure 1 below).

People Create Safety

Learning
and
Challenging

Tailored
and
Proportionate

Safety Intelligence

Figure 1:
Relative importance of Global Safety Strategy themes for CANSO APAC
Region (importance is proportionate to the size of the circles)

‘People Create Safety’ has been identified as the risks we face, and collaboratively finding common
most fundamental element for the region and is an solutions to make our skies safer and seamless for
enabling factor in implementing the other themes. airspace users. It is also about looking into the
It recognises that our people play a key role in future of ATM safety and integrating safety risk
delivering and assuring the safety of our operations. management practices in change management,
Considering the safety challenges in the APAC embedding SMS into business-as-usual practices,
region, near-term initiatives are focused around and managing all these proportionate to our
‘People Create Safety’, which aims at promoting respective operations.
positive safety culture, strengthening safety
accountabilities and developing competencies of Underpinning ‘Learning and Challenging’ and
our people to understand and manage safety risks ‘Tailored and Proportionate’ themes are longer-
effectively. term opportunities for developing the ‘Safety
Intelligence’ framework in the region (including
Implementing ‘Learning and Challenging’ and defining the concept of ‘Safety Intelligence’).
‘Tailored and Proportionate’ adopts a two- The objectives include aligning metrics and
pronged approach. It is recognised that the methodologies of assessing safety performance,
ANSPs in the region are constrained by resources. understanding our changing operational contexts
There are ongoing opportunities for sharing and and emerging risks, assessing the performance of
capturing lessons learned across ANSPs, targeting our risk controls and benchmarking SMS maturity
improvement actions proportionate to the safety for continuous improvement.

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 APAC Regional Safety Implementation Strategy 2nd Edition

4
Key Safety Priorities

During 2013-2015, the CANSO APAC Safety culture, fatigue management, change management
Workgroup members undertook a number of and runway safety. The survey results, coupled
surveys to provide an understanding and baseline with the common regional safety challenges
measure of the region’s SMS implementation identified from CANSO Workgroup meetings, have
progress, common safety priorities and risk areas. highlighted the following key priorities for safety
The surveys included topics on SMS maturity, safety improvement in the APAC region.

Safety Strategy
Safety Improvement Areas
Themes

People Create Safety • Awareness, understanding and practical application of Just Culture
• Defining and implementing safety accountabilities and
responsibilities
• Driving positive safety culture and continuous safety improvement
from the leadership
• Developing and delivering training, communication and education
to equip all staff in the organisation to effectively adopt safety
processes, understanding risk and manage change
• Understanding human factors in ATM operations.

Learning and • Collaborating and sharing learning across the region to address
Challenging common safety risks.

Safety Intelligence • Identification and analysis of operational risk management

• Improving safety promotions including systematic sharing of lessons
learnt from investigations and other safety assurance activities
• Improving the quality of safety reports and analysis
• Developing and understanding safety performance measures
• Integrating safety risk management practices in change management
• Embedding safety risk management system into business-as-usual
practices

Tailored The ethos of the APAC region is to be cognisant of this theme at all
and Proportionate times when working on safety improvement initiatives. Efforts must
be proportionate to the resources available to benefit all Members,
as far as practicable.

Table 1:
CANSO APAC Region Safety Improvement Areas

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 APAC Regional Safety Implementation Strategy 2nd Edition

5
Safety Implementation Plans and Progress

The safety implementation plans aim to address the members of the CANSO APAC Safety Workgroup,
identified safety risk areas and safety improvement further insight has been gained into the evolving
areas. maturity and safety improvement needs of the
region. As a result, the safety implementation plans
The safety implementation plans are based have been redefined to focus the Workgroup’s
around the themes of People Create Safety, Safety efforts. Some of the historical initiatives have been
Intelligence and Learning and Challenging. There closed based on the progress of work undertaken,
are no specific initiatives for the Tailored and while others have been carried forward. The
Proportionate theme. The APAC Safety Workgroup previous delineation between tactical and strategic
intends to conduct all activities in a tailored and implementation plans have been removed for
proportionate manner, taking into consideration simplicity.
the context, resources and risk of applicable
ANSPs. The rationale of consolidating the safety
implementation plans is outlined in Table 2, with
Table 2 summarises the safety implementation the resulting changes illustrated in Figure 2. Table
plans that were initially defined in Version 1 of this 3 summarises the progress against the redefined
document, published in March 2016. Through safety implementation plans as at December 2018.
the collaborative work and discussions between

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 APAC Regional Safety Implementation Strategy 2nd Edition

Table 2: Safety Implementation Plans in Edition 1 of the Document (March 2016) and Rationale for Consolidation of Activities

Safety
Consolidation
Strategy Safety Implementation Plans Rationale for Consolidation
of Activities
Themes

1.0 1.1 Develop understanding for safety culture and Closed Safety culture workshop held during APAC Safety WG in
People review step-by-step guide to safety climate May 2015. There is no further regional requirement for a
Create surveys. step-by-step guide, due to sufficient materials available on
Safety Global ATM-net.

1.2 Create awareness and embed Just Culture in Activity commenced Just Culture covered in safety culture workshop during APAC
investigation and reporting processes, building and merged into Safety WG in May 2015.
on existing CANSO guidance material. new initiative

1.3 Develop and manage repository of safety Activity commenced Repository started on Global ATM-net APAC Safety WG
materials for APAC to develop knowledge base and carried forward pages.
with document links to CANSO materials.

1.4 Enhance understanding of risk management for Activity commenced Presentations and updates provided by Airways NZ on its
operational staff through programmes such as and merged into experience with PULSE in December 2014, November 2015
the Airways New Zealand training programme, new initiative and November 2017.
‘PULSE’ incorporating a focus on professionalism

1.5 Fatigue management in APAC. Closed Ops/Safety workshop held on fatigue in May 2015. Materials
available on Global ATM-net. ICAO/CANSO/IFATCA
Fatigue Management Guide for Air Traffic Service Providers
published.

1.6 Enhance understanding and management of Closed Ops/Safety Workshop held May 2017.
human factors and human performance in ATM
operations and investigation.

1.7 Strengthen safety mindset from leadership/ top Activity commenced In May 2017, APAC Safety WG requested guidance material
management to the frontline personnel and merged into for training senior leadership on Just Culture.
new initiative

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 APAC Regional Safety Implementation Strategy 2nd Edition

Safety
Consolidation
Strategy Safety Implementation Plans Rationale for Consolidation
of Activities
Themes

2.0 2.1 Apply change management for APAC ANSPs. Activity commenced Ops/Safety workshop on change management held in May
Learning and merged into 2017.
and new initiative
Challenging
2.2 Delivery of Runway Safety initiatives Activity commenced Some APAC Members are involved in the trialling and
Establishing runway incursion criteria and merged into implementing the CANSO Runway Safety Survey involving
Sharing best practices on runway safety new initiative Aerodrome Operators and ANSPs.
Integrating CANSO runway safety materials
with APAC ANSPs.

2.3 Industry collaboration and stakeholder Closed SilkAir presented on ATC/pilot risk management at the APAC
engagements. ATC/ pilot risk Safety WG meeting in November 2015.
management seminar.

2.4 Integrate SMS into the management of Not yet commenced

change and business operations. and merged into
new initiative

2.5 Develop regional threat and error Not yet commenced

management framework. and merged into
new initiative

2.6 Adopt whole-of-organisation safety approach. Not yet commenced *Considered as a philosophy rather than a specific initiative.
and closed*

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 APAC Regional Safety Implementation Strategy 2nd Edition

Safety
Consolidation
Strategy Safety Implementation Plans Rationale for Consolidation
of Activities
Themes

3.0 3.1 Identify risks in operations. Activity commenced Risk Analysis Tool (RAT) training conducted in November
Safety Implement common safety risk methodologies. and merged into 2016. RAT uptake within the region was discussed in
Intelligence Enhance the understanding and management new initiative November 2017, including sharing successes and challenges
of risk information in ATM operations. with the tool.

3.2 Sharing Safety Intelligence across APAC. Activity commenced Discussed in every APAC Safety WG meeting, with sharing
and merged into of ANSPs’ safety improvement initiatives and available
new initiative benchmarking information. The Global ATM-net continues
to provide a key source of safety intelligence available for
the region.

3.3 Identify emerging safety risks in ATM operations. Activity commenced Reoccurring agenda item at WG meetings.
and merged into
new initiative

3.4 Implement common framework for risk Activity commenced As per 3.1.
management, monitoring and analysis. and merged into
new initiative

3.5 Measure leading indicators for SMS. Activity commenced SEANS-Safety encouraged in the region. Five APAC ANSPs
and merged into have completed SEANS-Safety assessments. Lead indicators
new initiative being developed by Future Safety Development WG could
be applicable for the region. SEANS-Safety training day held
in May 2017.

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 APAC Regional Safety Implementation Strategy 2nd Edition

Figure 2: Re-defined Safety Implementation Plans (December 2018)

1.0 People Create Safety 2.0 Learning and Challenging

1.1. Workshop on Safety Culture and Just 2.1 Workshop on APAC Runway Safety and sharing of
Culture for senior leadership roles best practices
1.2. Workshop on Threat and Error Management (TEM) 2.2 ATC Ops Safety Change Management Framework
1.3. Presentation of de-identified occurrence case studies 2.3 Promotion of SMS courses in region
1.4. Train the trainer courses for: 2.4 FRMS implementation – sharing experiences
- Manager safety awareness 2.5 Discovery of other risk assessment tools/methods
- Operational staff risk management and
professionalism (e.g. PULSE)
- Safety accountability
- Safety culture
1.5 Incorporation of human factors considerations
into occurrence review and investigations

3.0 Safety Intelligence 4.0 Reoccurring agenda items/activities at

3.1 Promotion to CEOs/DGs for the uptake of SEANS-Safety in APAC
each APAC Safety Workgroup meeting
3.2 Encourage the adoption of risk analysis tool (RAT) across region 4.1 Development and management of repository of safety
3.3 Encourage participation in identified and de- materials on Global ATM-net – safety knowledge base
identified benchmarking activities across region 4.2 Sharing of individual ANSP safety improvement
3.4 Review and discuss the APAC contributing initiatives and experiences across the region
factors (from global data) 4.3 Identifying emerging safety risks in the region
3.5 APAC alignment of occurrence classifications and definitions 4.4 Determining status of RAT implementation across APAC
3.6 Building a safety intelligence picture for the region (Top 4.5 Determining status of APAC ANSPs that have
3 risks, mitigating measures, risk severity level) undertaken SEANS-Safety assessment
3.7 Encourage uptake of leading indicators for SMS

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 APAC Regional Safety Implementation Strategy 2nd Edition

Table 3: Re-defined (December 2018) Safety Implementation Plans and their progress (December 2018)

Safety
Strategy Safety Implementation Plans Status Description of Progress
Themes

1.0 1.1 Workshop on Safety Culture and Just Planned for 2019 Safety Culture Workshop targeting senior leadership planned
People Culture targeting senior leadership roles. for May 2019 as part of the CANSO Asia Pacific Conference.
Create
Safety 1.2 Workshop on Threat and Error Completed TEM workshop conducted during the APAC Safety Workgroup
Management (TEM). meeting on 7 June 2018.

1.3 Presentation and discussion of de- Ongoing Ongoing sharing of safety improvement activities by APAC
identified case studies. ANSPs as a standing agenda item of the APAC Safety
Workgroup meetings.

1.4 Train the trainer courses for: Not yet commenced Presentations and updates provided by Airways NZ on its
• Manager safety awareness experience with PULSE in December 2014, November 2015
• Operational staff risk management and November 2017.
and professionalism (e.g. PULSE).
• Safety accountability
• Safety culture.

1.5 Incorporating human factors considerations Planned for 2019 A workshop on fatigue risk management planned for May
into occurrence review and investigations. 2019 as part of evolving the region’s maturity in relation to
human performance management (HPM).

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 APAC Regional Safety Implementation Strategy 2nd Edition

Safety
Strategy Safety Implementation Plans Status Description of Progress
Themes

2.0 2.1 Workshop on APAC Runway Safety Commenced Runway safety workshop conducted during the APAC Safety
Learning and sharing of best practices. on APAC Safety Workgroup meeting in December 2018 (including key results
and Workgroup meeting from a regional runway safety survey).
Challenging on 6 December
Ongoing promotion of ICAO and CANSO runway safety
2018 and to
tools, such as CANSO runway safety checklist.
continue into 2019
Further work planned in 2019, focusing on supporting the
establishment of Local Runway Safety Team (LRST), ongoing
sharing of runway safety intelligence and best practices and
establishing a mechanism for assessing the regional runway
safety performance.

2.1 ATC Operational Safety Change Commenced Safety workshop on “Managing Change and Human Factors”
Management Framework. conducted during APAC conference on 5 May 2017.

2.3 Promotion of SMS courses in the region. Not yet commenced

2.4 FRMS implementation – sharing experiences. Planned for 2019 Presentations and updates provided by Airways NZ on its
experience with PULSE in December 2014, November 2015
and November 2017.

2.5 Discovery of other risk assessment Not yet commenced

tools/methods.

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 APAC Regional Safety Implementation Strategy 2nd Edition

Safety
Strategy Safety Implementation Plans Status Description of Progress
Themes

3.0 3.1 Promotion to CEOs/DGs for the Commenced Adoption of SEANS-Safety and RAT actively being
Safety uptake of SEANS-Safety in APAC. encouraged in the region.
Intelligence
3.2 Encourage the adoption of RAT (risk The progress of lead indicators development by the CANSO
analysis tool) across region. Future Safety Development WG being monitored to be
considered for adoption in the region when available.
3.3 Encourage participation in identified and de-
identified benchmarking activities across region.

3.4 Review and discuss the APAC contributing

factors (from global data).

3.5 APAC alignment of occurrence

classifications and definitions.

3.6 Building a safety intelligence picture

for the region (Top 3 risks, mitigating
measures, risk severity level).

3.7 Encouraging uptake of leading indicators for SMS.

4.0 4.1 Number of APAC ANSPs which are utilising RAT. Planned for The status of APAC ANSPs utilising RAT to be reported in
Reoccurring May 2019 May 2019.
activities
4.2 Number of APAC ANSPs undertaken Commenced The status of APAC ANSPs’ experiences and lessons learned
SEANS-Safety assessment. and ongoing from SEANS-Safety assessments to be reported in 2019.

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6
Document Review

This document will be reviewed annually by the environment and ensure alignment with the
CANSO APAC Safety Workgroup. This is to ensure evolution of the CANSO Global Strategy. Updates
that the priorities for regional safety improvement to the progress on the safety implementation
and supporting implementation plans continue to strategies will be made annually.
adapt to ongoing changes in the regional aviation

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Document Amendments

DATE DETAIL

March 2016 First edition

December 2018 Second edition

Updated the implementation progress to December 2018

Consolidated and refocused initiatives and recurring activities, adapting

to the evolving maturity and safety improvement needs of the region.

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APAC Regional Safety Implementation Strategy 2nd Edition

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